But your skin is not there just to look beautiful, keep your organs dry, and provide proof of your recent trip to the beach. It also protects you from infection, regulates your body temperature, prevents fluid loss, and generates important chemicals like vitamin D.
Unfortunately, your skin can and often does become marred by dryness, rashes, and infections, which can be unsightly and uncomfortable. So you’ve got a rash. Should you just fill your bathtub with oatmeal, like the internet suggests, and hope it goes away? Or is it time to pay a visit to your dermatologist?
Take a Chill Pill
You don’t have a visible rash but your skin feels itchy, flaky, or tight all over. You may simply have dry skin. The risk increases in cold weather (because the air is less humid) and with increasing age. Make sure your soap or body wash has some built-in moisturizer. After a shower or bath, use your towel to dab the water off your skin, rather than wiping it. Moisturize twice daily, including right after drying off. If your hands are particularly dry, it could be from washing them too often or doing frequent wet work, like washing dishes. Moisturize your hands right after washing them, and wear gloves as needed to prevent your hands from getting wet. For extra dry skin, use a petrolatum-based product (like Vaseline). Dry skin can itch and crack, predisposing you to infection, so if you can’t control your symptoms with drugstore products, speak to your doctor.
You have red, itchy skin and just changed your brand of hand soap or laundry detergent. Many people can develop skin reactions to the chemicals contained in soaps and detergents. Try switching to an additive-free or gentle brand that does not contain extra scents or optical brighteners.
Your skin is burned, painful, and red after a day in the sun. A bad sunburn is more than an unpleasant souvenir from the boardwalk. It also significantly increases your risk of developing skin cancer later in life. (Indeed, only five sunburns during adolescence increases your risk of melanoma by 80 percent!) Prevention is essential. If you’re going to be in the sun all day, apply a palm-sized amount of sunscreen that has UVB protection and SPF 30 or greater, then reapply every two hours. If you go swimming, reapply after drying off (even if the bottle claims water resistance). If you’re expecting just short periods of sun exposure, at least apply sunscreen to your face. If you do get a burn, make sure you drink plenty of fluids, and apply calamine lotion or aloe vera to the affected areas. If you have lots of pain, try ibuprofen/Advil/Motrin. If you have small blisters, don’t pop them; however, if the blisters do break on their own, gently clean them with soap and water, apply an over-the-counter antibiotic ointment, and cover with a bandage. If you have extensive burns, large blisters, headache, and/or severe pain, you need to see your doctor pronto.
You’re growing a second skin—in your uterus. Itchy, dry skin is common during pregnancy because of changing levels of hormones that affect the skin. In addition, women with a history of eczema may experience worsening symptoms during pregnancy. Less often, pregnant women experience a skin condition known as pruritic urticarial papules and plaques of pregnancy, or PUPPP, which causes itchy, red bumps on the belly (often around stretch marks). It is not dangerous, usually goes away within a few weeks, and improves with steroid cream. Pregnant women can also develop a more serious condition known as intrahepatic cholestasis of pregnancy, which causes yellowing of the skin and eyes along with severe itching, particularly over the palms and soles. This condition can progress to serious liver disease and requires urgent evaluation.
You have an itchy, ring-shaped, red rash on your skin. You probably have a fungal infection called ringworm. Thankfully there are no actual worms involved; the name just comes from the fact that the rash looks like a raised, red worm. The fungus is contagious and can even be spread by your pet (maybe not always a man’s best friend). Treat ringworm with a daily dollop of over-the-counter antifungal cream, like clotrimazole/Desenex, for two weeks.
You have the feet of an athlete—but, sadly, not the abs. Athlete’s foot is a fungal infection that causes an itchy, scaly, red rash on the feet, especially between the toes. The rash can occasionally spread to your palms, groin (jock itch), inner thigh, and buttocks. You can treat the rash using antifungal creams or sprays, like terbinafine/Lamisil, for one to four weeks. If it doesn’t go away, you may need a prescription for an oral antifungal medication. To prevent repeated infection, wear flip-flops in common shower areas, where the fungus likes to lie in wait. In addition, apply antifungal foot powders before your feet get hot and sweaty, since those are perfect conditions for fungal growth.
Your nose and/or cheeks are always red, with some visible blood vessels. You may have a chronic condition known as rosacea, which mostly affects smokers and light-skinned women over the age of thirty. The redness usually gets worse after you drink alcohol, eat spicy foods, spend time in the sun, exercise, or go out in very cold or very hot temperatures. Rosacea can also cause acne-like bumps on your face, thickening of the skin on the nose and cheeks (known as rhinophyma), and dry eyes. Unfortunately, there is no permanent fix for rosacea. Your skin may look better, however, with regular application of moisturizer/sunblock and avoidance of known triggers. If your symptoms remain severe, your dermatologist may offer additional treatments, such as antibiotics (like metronidazole gel/Metrogel).
You got tagged, but you weren’t even it. About half of us have outgrowths of normal skin, known as acrochordons, or skin tags, that hang from the surrounding skin by a narrow stalk. Skin tags are not dangerous, but your doctor can remove them if they are visible or bothersome.
Did you let the bed bugs bite? Did you wake up in the morning with red, itchy, small bumps on your body? Are you afraid you have bed bugs? Are you ready to burn down your entire home as a precautionary measure? Bedbugs are frequently feared, rarely seen critters that can hide underneath your mattress and behind your furniture. They are about the size of Lincoln’s face on a penny. They get into your home from adjacent apartments, or on used furniture, suitcases, or other objects that were previously in a room with bedbugs. (When you travel, don’t leave your suitcase on the bed or floor; use the folding rack.) Bedbugs love to drink your blood but hate to be in the light, so they only attack at night. They bite exposed areas of skin, like your face, neck, arms, and hands. The resulting itchy, red bumps last for about a week. Steroid creams and oral antihistamines (like diphenhydramine/Benadryl) can reduce the itch. To diagnose bedbugs, you’ll need to hire a pest control service to confirm your home is actually infested. If you have bedbugs, they’ll help you decontaminate your home. If no bedbugs are found, you should see your doctor to get an alternative explanation for your rash.
Make an Appointment
You have itchiness that does not improve with moisturizer, affects your entire body, and lasts for more than two weeks. In rare cases, itchy skin can result from diseases of the kidneys, liver, thyroid gland, nerves, or blood cells. Your doctor will likely perform some blood tests to help screen for some of the more common causes.
You just started a new medication. Many medications—including pain medications, antibiotics, and antifungal medications—can cause rashes and itchiness, usually within five to seven days of starting them. If you develop a rash soon after starting a new medication, contact your doctor right away. If you develop a fever and sores in your mouth, you may be having a more serious medication reaction and should get to the E.R. pronto.
You have itchy, scaly plaques on your elbows, knees, or scalp. You may have psoriasis, which causes plaques that are sharply distinct from surrounding normal skin. The plaques often have a silver-like coating, which may disappear when wet or rubbed with lotion. The lower back, hands, feet, and ears are also frequently involved. Because psoriasis is an autoimmune disease, the treatment usually involves steroid creams and, in severe cases, immune-suppressing medications.
You’ve been getting dry, itchy rashes in your neck, elbow, and/or knee creases since childhood. You likely have eczema, also known as atopic dermatitis. The problem usually starts in
childhood and either goes away or, in some people, continues into adulthood. Many people with eczema also have asthma and food allergies. To avoid skin flare-ups, use moisturizers, avoid long showers, use warm water (instead of hot water) in the shower or bath, and avoid anything that triggers your rash (certain soaps, foods, stress, sweat). The treatment of mild flares is usually just a moisturizer and low-dose steroid cream, available without a prescription at the drugstore. If the itching is bad, take an antihistamine like diphenhydramine/Benadryl. More severe outbreaks may require prescription-strength creams or a treatment called phototherapy (intentionally exposes your skin to ultraviolet rays). Take care not to scratch too much or too hard, as you can create breaks in the skin that may become infected.
You have a painful, warm, red area of skin, along with fever and chills. You probably have an infection of the skin and underlying soft tissue, known as cellulitis. If part of the infected area is raised and slightly mushy, you could have an abscess. As the infection progresses, it will involve a larger area of skin, and red streaks may spread outward into the normal skin. Cellulitis requires treatment with antibiotics; if you also have an abscess, it may require drainage. If you can’t get an appointment with your doctor right away, visit an urgent care center or E.R.
You have pain followed by a blistering rash on one side of your body or face. You may have shingles, caused by reactivation of the chickenpox virus. The virus travels through your nerves to a slice of skin on one side of the face, chest, or back. If the rash is diagnosed early in its course, it may respond to treatment with antiviral medications. It some cases, the virus causes intense pain that lasts for several weeks after the rash has improved. Be sure to tell your doctor if you have any ongoing pain, since medications can relieve some of the sting. In rarer cases, the virus can affect the eyes and cause vision loss.
Of note, if you’re older than fifty, you should speak to your doctor about whether you should get the shingles vaccine to prevent these complications altogether.
You have an intensely itchy rash in the webs of your fingers, wrist, armpits, genitals, knees, and feet. We regret to inform you that you may have scabies. The transmission of the tiny mites that cause scabies usually occurs during direct and prolonged skin contact with a family member or roommate. The mites burrow into the skin and cause intense itchiness and small red dots. The rash spreads to multiple body parts (most often the ones listed above) but does not usually affect the head or back. The itchiness gets worse at night. If your doctor agrees that you have scabies, you’ll have to apply a special cream to your skin for about twelve hours (usually overnight) and launder any surfaces you’ve laid on during the past three or four days (like bedsheets, couch cushions, and so on). Time to redecorate!
You have a mole that is getting bigger or darker. A simple mole can, over time, turn into a dangerous type of skin cancer known as melanoma. Likewise, a new mole may in fact already be melanoma. Your doctor should routinely check your entire body for suspicious-looking moles. But what counts as suspicious? Doctors sometimes use the ABCDE checklist of bad signs: asymmetry, irregular border, variable coloring, diameter of greater than 6 mm (larger than a pencil eraser), evolution (new or changing). If the lesion is raised/thick, that’s another bad sign. The early detection and treatment of melanoma is crucial, since it’s the sixth most common type of cancer in the United States, and survival is poor if treatment is delayed.
Both your arms are itchy, and it’s getting on your nerves. Your itchiness may be due to a problem with your nerves, rather than your skin. Brachioradial pruritus is a somewhat mystifying condition, possibly the result of nerve impingement, that causes significant itchiness in your neck, shoulders, upper arms, and/or forearms. Icing the skin makes the itching better, while sun exposure makes it worse. Try applying an over-the-counter capsaicin cream or patch. If that fails, your doctor may prescribe a medication that helps calm irritated nerves, like gabapentin/Neurontin or pregabalin/Lyrica.
You have a red rash across your cheeks and the bridge of your nose, which abruptly stops at the inner folds of your cheeks. You have a pattern described as “malar rash” (also known as “butterfly rash”). One common explanation is a yeast infection of the skin known as seborrheic dermatitis, which causes a scaly red facial rash that is sometimes in this pattern. In many cases, however, the rash actually extends onto the forehead and scalp. The treatment is antifungal and steroid creams.
Another potential explanation is rosacea, described here.
The least common but most feared explanation for a malar rash is lupus, an autoimmune disease that typically affects young women. Like rosacea, the malar rash of lupus can get worse with sun exposure. Unlike rosacea, it shouldn’t get worse with consumption of spicy foods or alcohol. A thorough examination (and potentially some blood tests) can determine which of these conditions is responsible for your rash.
You have been in the woods or tall grasses and now have a rash that looks like a bull’s eye. Lyme disease results from an infection with the bacteria Borrelia burgdorferi, which is transmitted through deer tick bites. Only about one in four people with Lyme disease realize they had a tick bite. In most people, however, the first sign of Lyme disease is a rash known as erythema migrans that looks like a large red spot surrounded by a red circle, with normal-colored skin in the middle. (Think of the Target logo.) The ring moves outward over the course of a few days, hence the name migrans (for “migrating”). Antibiotics are highly effective at this early stage and can prevent the long-term complications of Lyme disease, like joint pain and heart problems.
You spent years in the sun and now have a rough, crusty, yellowish skin patch. You likely have an actinic keratosis, or AK, a thick, crusty, sandpaper-like area of skin most commonly found on sun-exposed areas (like the face, ears, neck, scalp, and backs of your hands). AKs can turn into squamous cell carcinoma, a type of skin cancer, so you should tell your doctor about them. The most common treatment is removal with liquid nitrogen.
You have a waxy, raised, brown growth that looks stuck on the skin. You likely have a seborrheic keratosis, or SK, which typically appears in middle age or later. The surface is usually irregular and wart-like. SKs are sometimes called human barnacles, because they just stick on and don’t really do any harm. Nonetheless you should show your doctor just to be safe, since these can sometimes look like (or actually be) melanoma. SKs don’t require treatment but can be removed if they’re bothersome.
You feel a rubbery lump under your skin that moves easily when pressed with your fingers. You likely have a lipoma, an enclosed collection of fat in the deepest layer of your skin. These lumps tend to run in families (are you part camel?). Lipomas don’t cause any harm but can be removed if they are unsightly. In rare cases, they can morph into a real tumor known as liposarcoma, so your doctor should periodically check them for any changes.
Get to the E.R.
You have hives (splotchy red rash all over) along with tingling/swelling of your tongue or throat, nausea, or difficulty breathing. You may be experiencing a severe allergic reaction known as anaphylaxis, which can occur in response to foods or medications. The most common food culprits are peanuts, eggs, fish, shellfish, and tree nuts (like almonds and walnuts). The rash usually responds to antihistamines, like diphenhydramine/Benadryl, though severe cases (with breathing problems) require steroids and an emergent injection with epinephrine (from an EpiPen).
You have fever and painful, purplish blisters on your skin, lips, and the inside of your mouth. You may also have red, painful eyes. You may have a life-threatening condition known as Stevens-Johnson syndrome/toxic epidermal necrolysis, or SJS/TEN. It’s a rare but very serious reaction to a medication or, less often, an infection. Your skin can literally detach from your body, resulting in severe fluid losses and infection. Affected people require treatment in a burn unit.
Hair Loss
EDITED BY LINDSEY BORDONE, M.D.
It’s a cruel trick of nature, but men often lose the hair
on their head while retaining a thick, unsightly mane on their neck, their back, their . . . well, you know. It doesn’t even make sense: Does evolution want you to sunburn your scalp? Should you be applying suntan lotion to your bald spot? (Yes.)
Hair loss, or alopecia, is extremely common and affects both sexes. Men usually start to see extra hair in the brush by their late thirties. Most hair loss can be blamed on genes from both parents; it’s only a myth that hair loss is passed down from your mother’s father.
There are three stages of normal hair growth. Ninety percent of your hair is in the anagen (growth) stage, which can last for years and determines the maximum length of your hair. The rest of your hairs are already in the catagen stage, in which they loosen their grip on their follicles, or telogen (resting) stage, a sort of purgatory that lasts until the hairs finally relocate to your shower drain.
Hair loss is usually a normal part of aging and not a sign of underlying disease. In rare cases, however, it can result from emotional stress, illness, and hormonal changes. So where should the ambulance go—to the hospital or the Hair Club?
Take a Chill Pill
Out with the old and in with the new. It’s normal to shed about a hundred hairs each day. (Please don’t actually count them.) The good news is that it’s also normal to grow about a hundred new hairs each day. As long as losses and gains are balanced, you should still have about 100,000 to 150,000 hairs on your scalp.
You’re bald, look just like your dad (or, worse, just like your mom). Androgenetic alopecia is the official term for male- or female-pattern baldness. It’s most common in white men, about half of whom have hair loss by age fifty. Women usually keep their hair a bit longer, though a third of white women have hair loss by age seventy. Most men lose hair on the top and front of their heads, sparing the sides. Women get a more generalized thinning-out. As described in the Quick Consult, many, many medications and procedures have been created to treat baldness, though results have been mixed. (We have officially deleted our hair plug joke, so as to avoid an interview with the Secret Service.) Another option is hair transplantation surgery, in which healthy hair follicles are transferred from one part of your scalp (or body, if necessary) to a bald spot. If you’re planning to go this route, make sure you see pictures of your doctor’s real past patients so you know what to expect.
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